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1.
PLoS One ; 16(12): e0260798, 2021.
Article in English | MEDLINE | ID: covidwho-1599553

ABSTRACT

Despite remarkable academic efforts, why Enterprise Resource Planning (ERP) post-implementation success occurs still remains elusive. A reason for this shortage may be the insufficient addressing of an ERP-specific interior boundary condition, i.e., the multi-stakeholder perspective, in explaining this phenomenon. This issue may entail a gap between how ERP success is supposed to occur and how ERP success may actually occur, leading to theoretical inconsistency when investigating its causal roots. Through a case-based, inductive approach, this manuscript presents an ERP success causal network that embeds the overlooked boundary condition and offers a theoretical explanation of why the most relevant observed causal relationships may occur. The results provide a deeper understanding of the ERP success causal mechanisms and informative managerial suggestions to steer ERP initiatives towards long-haul success.


Subject(s)
Delivery of Health Care, Integrated/organization & administration , Efficiency, Organizational/standards , Financial Management, Hospital/methods , Health Care Rationing/standards , Health Resources/organization & administration , Hospital Information Systems/standards , Resource Allocation/methods , Humans , Planning Techniques , Software
2.
J Cyst Fibros ; 20 Suppl 3: 1-2, 2021 12.
Article in English | MEDLINE | ID: covidwho-1587341

ABSTRACT

The findings of this body of work are presented in the eight articles included in this supplement. The impact and perspectives of adult and pediatric care teams and patient/families are covered with special attention to mental health care, the financial and personnel impacts within care programs, the experiences of vulnerable and underrepresented patient populations, and implementation of remoting monitoring. Commentaries from colleagues provide a broader perspective, offering reflections on the findings and their implications regarding the future CF care model.


Subject(s)
COVID-19 , Cystic Fibrosis , Delivery of Health Care, Integrated/organization & administration , Delivery of Health Care/trends , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Continuity of Patient Care , Cystic Fibrosis/epidemiology , Cystic Fibrosis/therapy , Health Services Accessibility/organization & administration , Health Services Accessibility/trends , Humans , Organizational Innovation , SARS-CoV-2 , Telemedicine/organization & administration , Telemedicine/standards , United States/epidemiology
3.
Medicine (Baltimore) ; 100(41): e27399, 2021 Oct 15.
Article in English | MEDLINE | ID: covidwho-1501200

ABSTRACT

ABSTRACT: The novel coronavirus disease 2019 (COVID-19) pandemic has intensified globally since its origin in Wuhan, China in December 2019. Many medical groups across the United States have experienced extraordinary clinical and financial pressures due to COVID-19 as a result of a decline in elective inpatient and outpatient surgical procedures and most nonurgent elective physician visits. The current study reports how our medical group in a metropolitan community in Kentucky rebooted our ambulatory and inpatient services following the guidance of our state's phased reopening. Particular attention focused on the transition between the initial COVID-19 surge and post-COVID-19 surge and how our medical group responded to meet community needs. Ten strategies were incorporated in our medical group, including heightened communication; ambulatory telehealth; safe and clean outpatient environment; marketing; physician, other medical provider, and staff compensation; high quality patient experience; schedule optimization; rescheduling tactics; data management; and primary care versus specialty approaches. These methods are applicable to both the current rebooting stage as well as to a potential resurgence of COVID-19 in the future.


Subject(s)
Ambulatory Care/organization & administration , Office Visits/statistics & numerical data , Telemedicine/organization & administration , Ambulatory Care/statistics & numerical data , COVID-19/epidemiology , Delivery of Health Care, Integrated/organization & administration , Humans , Kentucky/epidemiology , Pandemics , Primary Health Care/organization & administration , Quality Improvement , SARS-CoV-2
6.
BMJ Health Care Inform ; 28(1)2021 Sep.
Article in English | MEDLINE | ID: covidwho-1476575

ABSTRACT

OBJECTIVES: To implement a unified non-emergency medical transportation (NEMT) service across a large integrated healthcare delivery network. METHODS: We assessed needs among key organisational stakeholders, then reviewed proposals. We selected a single NEMT vendor best aligned with organisational priorities and implemented this solution system-wide. RESULTS: Our vendor's hybrid approach combined rideshares with contracted vehicles able to serve patients with equipment and other needs. After 6195 rides in the first year, we observed shorter wait times and lower costs compared with our prior state. DISCUSSION: Essential lessons included (1) understanding user and patient needs, (2) obtaining complete, accurate and comprehensive baseline data and (3) adapting existing workflows-rather than designing de novo-whenever possible. CONCLUSIONS: Our implementation of a single-vendor NEMT solution validates the need for NEMT at large healthcare organisations, geographical challenges to establishing NEMT organisation-wide, and the importance of baseline data and stakeholder engagement.


Subject(s)
Delivery of Health Care, Integrated , Transportation of Patients , Delivery of Health Care, Integrated/organization & administration , Humans , Transportation of Patients/organization & administration
8.
Rev Cardiovasc Med ; 22(3): 677-690, 2021 09 24.
Article in English | MEDLINE | ID: covidwho-1439022

ABSTRACT

Heart Failure (HF) is characterized by an elevated readmission rate, with almost 50% of events occurring after the first episode over the first 6 months of the post-discharge period. In this context, the vulnerable phase represents the period when patients elapse from a sub-acute to a more stabilized chronic phase. The lack of an accurate approach for each HF subtype is probably the main cause of the inconclusive data in reducing the trend of recurrent hospitalizations. Most care programs are based on the main diagnosis and the HF stages, but a model focused on the specific HF etiology is lacking. The HF clinic route based on the HF etiology and the underlying diseases responsible for HF could become an interesting approach, compared with the traditional programs, mainly based on non-specific HF subtypes and New York Heart Association class, rather than on detailed etiologic and epidemiological data. This type of care may reduce the 30-day readmission rates for HF, increase the use of evidence-based therapies, prevent the exacerbation of each comorbidity, improve patient compliance, and decrease the use of resources. For all these reasons, we propose a dedicated outpatient HF program with a daily practice scenario that could improve the early identification of symptom progression and the quality-of-life evaluation, facilitate the access to diagnostic and laboratory tools and improve the utilization of financial resources, together with optimal medical titration and management.


Subject(s)
Ambulatory Care/organization & administration , COVID-19 , Cardiology Service, Hospital/organization & administration , Delivery of Health Care, Integrated/organization & administration , Heart Failure/therapy , Telemedicine/organization & administration , Heart Failure/diagnosis , Heart Failure/epidemiology , Heart Failure/physiopathology , Humans , Patient Readmission , Prognosis
9.
Child Adolesc Psychiatr Clin N Am ; 30(4): 809-826, 2021 10.
Article in English | MEDLINE | ID: covidwho-1415269

ABSTRACT

Psychiatry and psychology have a long history of competition that too often interferes with the collaboration that can characterize complementary contributions to our common missions. We hope this article will inspire our disciplines to expand on this collaboration, for the sake of our children and families, our communities, our colleagues, and honestly, ourselves. We are better together than apart. This text is a blueprint for the assumptions, attitudes, skills, and advocacy that can make this partnership healthy and successful.


Subject(s)
Child Psychiatry/methods , Delivery of Health Care, Integrated/organization & administration , Primary Health Care , Psychology, Child/methods , Adolescent , Child , Humans , Interprofessional Relations , Intersectoral Collaboration , Mental Health , Models, Organizational , Primary Health Care/ethics , Primary Health Care/organization & administration
11.
Nurs Adm Q ; 45(4): 277-284, 2021.
Article in English | MEDLINE | ID: covidwho-1381059

ABSTRACT

This article provides insight into the impact of boundary spanning for nurse leaders in a large integrated post-acute health care system in the southeastern part of the United States as they responded (not reacted) to the COVID-19 pandemic that threatened the lives of 2 of society's most vulnerable populations, the elderly and the disabled. Through illustrative examples, the authors describe the 6 strategies of boundary spanning leadership-buffering, reflecting, connecting, mobilizing, weaving, and transforming-that enabled these nurse leaders to respond effectively during this crisis. The literature informs on the merit of situational leadership, as no single type of leadership is right for all circumstances. Today's new novel pandemic served as a powerful catalyst for a group of nurse leaders in a large non-acute network of health care organizations, their colleagues, and other key stakeholders to reframe the boundaries that existed between their organizations and associations, thus enabling them to successfully problem solve together to accomplish several high-stakes goals.


Subject(s)
COVID-19/nursing , Delivery of Health Care, Integrated/organization & administration , Leadership , Nurse Administrators/organization & administration , COVID-19/epidemiology , Humans , Pandemics , SARS-CoV-2 , United States/epidemiology
12.
Ann Fam Med ; 19(4): 356-361, 2021.
Article in English | MEDLINE | ID: covidwho-1325363

ABSTRACT

Interest and incentives are increasing around strategies whereby the health care sector can better identify and address patients' social and economic needs in the context of primary care delivery. This interest is likely to accelerate during the economic recession following the OVID-19 pandemic. Yet effective and sustainable strategies for integrating social care practices (eg, patient-facing social risk screening and activities to address identified needs) have not been clearly established. Lessons learned from more than 2 decades of research on behavioral health integration could be applied to efforts to integrate social care into primary care. In this article, we synthesize learnings from primary care and behavioral health care integration, and translate them into organizing principles with the goal of advancing social care integration practices to improve the health of both patients and communities.


Subject(s)
Behavioral Medicine/methods , Delivery of Health Care, Integrated/organization & administration , Mental Health Services , Primary Health Care/methods , Social Support , Humans , Patient Care Team
13.
BMC Fam Pract ; 22(1): 143, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1295441

ABSTRACT

BACKGROUND: Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams' delivery of mental health care. METHODS: A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. RESULTS: We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. CONCLUSIONS: From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care's capacity for mental health care for the duration of the pandemic and beyond.


Subject(s)
COVID-19 , Delivery of Health Care, Integrated/organization & administration , Mental Health Services , Patient Care Team/organization & administration , Primary Health Care , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Female , Focus Groups , Health Services Needs and Demand , Humans , Male , Mental Health/trends , Mental Health Services/standards , Mental Health Services/supply & distribution , Ontario/epidemiology , Practice Patterns, Physicians'/trends , Primary Health Care/methods , Primary Health Care/trends , Quality Improvement/organization & administration , SARS-CoV-2 , Telemedicine/methods , Telemedicine/statistics & numerical data
17.
Int J Gynaecol Obstet ; 152(2): 155-164, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1125963

ABSTRACT

Worldwide, health systems and care approaches vary widely due to local reality, distance to facilities, cultural norms, resources, staff availability, geography, and politics. Consequently, globally maternal-newborn dyad care and outcomes are highly variable, leading to approximately 800 maternal deaths daily with a 100-fold difference among high- and low-resource countries. Irrespective of where care is received, maternal safety and wellbeing should be preserved. Despite ongoing efforts, however, this is not the case. Large gaps exist between spending and clinical outcomes. Segmented health care, coupled with poor planning and inadequate resource distribution, results in failure to provide essential life-saving treatment. The proposed solution is a regional integrated care model from midwife to advanced level III/IV care and the newborn unit, achieved through effective coordination by site, staff, and clinicians. This model has been successfully implemented in high- to low-resource countries in the past 20 years. In the large diverse population of the United States, constructive steps have been implemented to reduce high maternal mortality in black and rural communities. The COVID-19 pandemic demonstrates the feasibility of rapid resources coordination to provide effective advanced care. The proposed integration of resources will have a major positive impact on the maternal-newborn dyad.


Subject(s)
Delivery of Health Care, Integrated/organization & administration , Delivery of Health Care/organization & administration , Health Resources/organization & administration , Infant Health , Maternal Health Services , African Americans , COVID-19 , Female , Humans , Infant, Newborn , Maternal Mortality , Midwifery , Pregnancy , Rural Population , United States
18.
Otolaryngol Head Neck Surg ; 164(2): 294-296, 2021 02.
Article in English | MEDLINE | ID: covidwho-1125766

ABSTRACT

The proportion of patients with residual olfactory and gustatory dysfunction after COVID-19 is increasing, and practical health care strategies need to be developed to manage this novel situation in otolaryngology services worldwide. Starting from our experience in a large Italian hospital, we estimated that >1500 people will complain of some form of olfactory and gustatory dysfunction in the future months in our region. We want to share our logistical and clinical integrated pathway that is aimed to screen and refer each patient to the most appropriate level of care in order to optimize resources and avoid overwhelming the available clinics.


Subject(s)
COVID-19/complications , Delivery of Health Care, Integrated/organization & administration , Olfaction Disorders/therapy , Olfaction Disorders/virology , Taste Disorders/therapy , Taste Disorders/virology , COVID-19/therapy , Female , Follow-Up Studies , Humans , Italy , Male , Middle Aged
19.
J Am Board Fam Med ; 34(Suppl): S203-S209, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1100014

ABSTRACT

The Coronavirus disease 2019 (COVID-19) pandemic has laid bare the dis-integrated health care system in the United States. Decades of inattention and dwindling support for public health, coupled with declining access to primary care medical services have left many vulnerable communities without adequate COVID-19 response and recovery capacity. "Health is a Community Affair" is a 1966 effort to build and deploy local communities of solution that align public health, primary care, and community organizations to identify health care problem sheds, and activate local asset sheds. After decades of independent effort, the COVID-19 pandemic offers an opportunity to reunite and align the shared goals of public health and primary care. Imagine how different things might look if we had widely implemented the recommendations from the 1966 report? The ideas and concepts laid out in "Health is a Community Affair" still offer a COVID-19 response and recovery approach. By bringing public health and primary care together in community now, a future that includes a shared vision and combined effort may emerge.


Subject(s)
COVID-19/therapy , Delivery of Health Care, Integrated/organization & administration , Primary Health Care/standards , Public Health/standards , COVID-19/epidemiology , Cooperative Behavior , Delivery of Health Care, Integrated/trends , Humans , Pandemics , Primary Health Care/economics , Primary Health Care/trends , Public Health/economics , Public Health/trends , SARS-CoV-2 , United States/epidemiology
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